Provider Demographics
NPI:1982812889
Name:TSAIOUN, KATHERINE (PHD, LDN)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:TSAIOUN
Suffix:
Gender:F
Credentials:PHD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 NEWBURG ST
Mailing Address - Street 2:#2
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2825
Mailing Address - Country:US
Mailing Address - Phone:508-812-0850
Mailing Address - Fax:617-812-0712
Practice Address - Street 1:57 RT 6A
Practice Address - Street 2:SUITE 2A
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2409
Practice Address - Country:US
Practice Address - Phone:508-812-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1815133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATSMT0467Medicaid
MATSMT0467Medicare ID - Type Unspecified